Hand surgical and injectable treatments in systemic sclerosis: A systematic review of published cases.

Abstract

Introduction: Systemic sclerosis is a systemic autoimmune disease that can affect the hands leading to a deterioration in function. Unfortunately, current medical treatments are considered insufficient to improve patients' quality of life. However, innovative surgical and injectable treatments are available.

Patients and methods: A systematic review of the literature on surgical and injectable treatments available to hand surgeons was carried out according to the PRISMA criteria. All the articles selected were analysed qualitatively and descriptively, and where possible the extracted data were summarised quantitatively.

Results and discussion: Twenty-nine articles were therefore included, comprising 704 patients and 546 procedures. Nine different treatments were identified. Botulinum toxin injections have shown promising clinical results in the treatment of Raynaud's phenomenon, digital ulcers and pain, but have not been confirmed in randomised placebo-controlled trials. Injections of adipose-derived stromal vascular fraction showed positive results in Raynaud's phenomenon, digital ulcer, pain and function, but not in randomised placebo-controlled trials. Autologous fat grafting has shown significant results in Raynaud Phenomenon (RP) and digital ulcers (DUs) healing and prevention. Peripheral sympathectomy has shown moderate beneficial effects with frequent adverse events, and should be reserved for severe cases. Transluminal angioplasty has shown encouraging results, but studies with a high level of evidence are needed. Finally, symptomatic calcinosis cutis should be treated by resection or carbon dioxide (CO2) laser. A treatment algorithm is provided in the Supplemental Appendix.

Conclusion: Interventional treatments for scleroderma of the hand have shown an overall trend of efficacy, but some of the beneficial effects have not been found in studies with a high level of evidence. Further well-conducted studies are needed.